From the Guidelines
For a 71-year-old female in significant distress, a benzodiazepine such as lorazepam (Ativan) would be an appropriate first-line agent to help her relax, as it is effective in providing sedation and anxiolysis, with a relatively favorable safety profile in elderly patients 1. A typical starting dose would be 0.5 mg orally, which can be repeated in 30-60 minutes if needed. For more severe distress, 1 mg may be appropriate. Due to her advanced age, starting with a lower dose is prudent as elderly patients are more sensitive to benzodiazepine effects and have increased risk of side effects, such as respiratory depression and systemic hypotension 1. Some key points to consider when using benzodiazepines in this patient population include:
- Lorazepam is preferred in older adults because it has no active metabolites, a relatively short half-life (10-20 hours), and doesn't require hepatic metabolism, making it safer in those with liver impairment 1.
- Before administering, it's essential to assess her vital signs, determine the cause of distress, and review her medication list for potential interactions.
- Common side effects include drowsiness, dizziness, and unsteadiness.
- Benzodiazepines work by enhancing the effect of GABA, an inhibitory neurotransmitter that reduces neuronal excitability in the brain, producing a calming effect.
- For longer-term management, addressing the underlying cause of distress rather than continued benzodiazepine use is recommended, as benzodiazepines are not considered part of the initial strategy in delirium management due to their sedating effects and association with falls 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sedation Options for a 71-Year-Old Female in Distress
- The patient's age and condition suggest the need for a carefully selected sedative to avoid adverse effects.
- Studies have compared the efficacy and safety of various sedatives, including lorazepam, midazolam, and propofol 2, 3, 4, 5, 6.
Comparison of Lorazepam and Midazolam
- A study published in 1999 found that lorazepam and midazolam had similar efficacy in sedating critically ill patients, but lorazepam was associated with more oversedation 2.
- Another study published in 2017 found that intramuscular midazolam and lorazepam had similar efficacy in treating acute agitation in non-elderly subjects, but the combination of benzodiazepines and antipsychotics was more effective 3.
- However, a 2025 study found that midazolam was associated with a higher risk of adverse events, including respiratory problems, in older adults with severe agitation 4.
Pharmacokinetics of Lorazepam and Midazolam
- A 2004 study found that the pharmacokinetics of lorazepam and midazolam varied significantly between patients, with factors such as age, alcohol abuse, and positive end-expiratory pressure (PEEP) affecting drug clearance 5.
- The study suggested that lorazepam may be a better choice for long-term sedation in critically ill patients due to its more predictable pharmacokinetics.
Clinical Implications
- Based on the available evidence, lorazepam may be a suitable option for sedating a 71-year-old female in distress, considering its efficacy and relatively predictable pharmacokinetics 2, 5.
- However, it is essential to carefully monitor the patient's response to the medication and adjust the dose as needed to avoid oversedation and other adverse effects 2, 4.